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NPI Code Detail

MEDICARE: MRS. SOFIA S KHAN M.D.

MEDICARE: MRS. SOFIA S KHAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician04-26409KS
2207R00000XInternal Medicine PhysicianM0111310MO
3208M00000XHospitalist Physician111310MO
4207R00000XInternal Medicine Physician111310MO

General Provider Information

NPI Number : 1770580730
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SOFIA S KHAN M.D.
Provider Business Mailing Address
First Line : 2845 W 139TH TER
Second Line :
City : LEAWOOD
State : KS
Zip : 66224-3931
Country : US
Telephone Number : 913-814-7182
Fax Number :
Provider Business Practice Location Address
First Line : 17844 E 23RD ST S
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64057-1840
Country : US
Telephone Number : 816-254-3652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2005
Last Update Date : 02/16/2022

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